<scp>A</scp>daptive deep brain stimulation controls levodopa‐induced side effects in <scp>P</scp>arkinsonian patients

Rosa, Manuela; Arlotti, Mattia; Marceglia, Sara; Cogiamanian, F.; Ardolino, Gianluca; Fonzo, Alessio Di; Lopiano, Leonardo; Scelzo, Emma; Merola, Aristide; Locatelli, Marco; Rampini, Paolo; Priori, Alberto

doi:10.1002/mds.26953

Cited by 108 publications

(126 citation statements)

References 6 publications

(6 reference statements)

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“…1B, lower green panel). aDBS substantially reduced the dyskinesias in patients on medication 37,38. In addition, the acute impact of aDBS on speech was assessed in 10 PD patients in a further study 28.…”

Section: Applications and Supporting Evidencementioning

confidence: 99%

“…aDBS substantially reduced the dyskinesias in patients on medication. 37,38 In addition, the acute impact of aDBS on speech was assessed in 10 PD patients in a further study. 28 The patients received bilateral aDBS and cDBS, but only cDBS caused an acute deterioration in speech, assessed through the blinded assessment of the speech intelligibility test.…”

Section: Applications and Supporting Evidencementioning

confidence: 99%

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Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy

et al. 2017

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Continuous high-frequency DBS is an established treatment for essential tremor and Parkinson’s disease. Current developments focus on trying to widen the therapeutic window of DBS. Adaptive DBS (aDBS), where stimulation is dynamically controlled by feedback from biomarkers of pathological brain circuit activity, is one such development. Relevant biomarkers may be central, such as local field potential activity, or peripheral, such as inertial tremor data. Moreover, stimulation may be directed by the amplitude or the phase (timing) of the biomarker signal. In this review, we evaluate existing aDBS studies as proof-of-principle, discuss their limitations, most of which stem from their acute nature, and propose what is needed to take aDBS into a chronic setting.

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Section: Applications and Supporting Evidencementioning

confidence: 99%

Section: Applications and Supporting Evidencementioning

confidence: 99%

Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy

et al. 2017

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“…Although studies have confirmed the efficacy of 'beta-based' aDBS [9][10][11][12][13], and suggested a superior side effect profile compared to continuous, conventional, DBS (cDBS) [14,15], these have been mostly performed in newly implanted patients. Such studies are potentially compromised by the microlesion effect [16], as this confounding factor provides temporary symptom relief, which can mask the true effects of stimulation.…”

Section: Introductionmentioning

confidence: 99%

Acute effects of Adaptive Deep Brain Stimulation in Parkinson’s disease

Piña-Fuentes

Dijk

Zijl

et al. 2019

Preprint

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249 Full text: 2804 Number of figures/tables: 4 Number of references: 39 Abstract Background: Beta-based adaptive Deep Brain Stimulation (aDBS) is effective in Parkinson's disease (PD), when assessed in the immediate post-implantation phase. However, the potential benefits of aDBS in chronically implanted patients, in whom the benefits of the microlesion effect have disappeared, are yet to be assessed. Methods: To determine the effectiveness and side-effect profile of aDBS in PD compared to conventional continuous DBS (cDBS) and no stimulation (NoStim) in the chronically implanted state. 13 PD patients undergoing battery replacement were pseudo-randomised in a crossover fashion, into three conditions (NoStim, aDBS or cDBS). Patient videos were blindly evaluated using a short version of the Unified Parkinson's Disease Rating Scale (subUPDRS) and the Speech Intelligibility Test (SIT). Results: Patients had a mean disease duration of 16 years, and the mean time since DBS implantation was 6.9 years. subUPDRS scores (11 patients tested) were significantly lower both in aDBS (p=<.001), and cDBS (p=.001), when compared to NoStim. Bradykinesia subscores were significantly lower in aDBS (p=.002), but not in cDBS (p=.08), when compared to NoStim. SIT scores of patients with stimulation-induced dysarthria (11 patients tested) significantly worsened in cDBS (p=.009), but not in aDBS (p=.407), when compared to NoStim. Overall, stimulation was applied 48.8% of the time during aDBS. Conclusion: Beta oscillations remain informative of the clinical state in patients with advanced PD, after several years of DBS implantation. Beta-based aDBS is as effective as cDBS for PD in chronically implanted patients, but delivers less stimulation, and has a more favourable speech side-effect profile.

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“…A number of proof‐of‐concept studies using beta‐LFPs to modify aDBS have shown motor improvement, less speech impairment, and less levodopa‐induced dyskinesia compared to cDBS, which suggests that this is a more efficient and effective method of stimulation. Moreover, a recent study demonstrated the feasibility and beneficial effects on motor symptoms of aDBS over the course of 8 hours in akinetic‐rigid PD patients .…”

Section: Adbs Based On Electrophysiological Recordingsmentioning

confidence: 99%

“…Such differentiation of clinical indications underlines the potential of STN-LFP recordings as promising input signals, with the added benefit of not requiring additional implants or equipment compared to cDBS. 17 A number of proof-of-concept studies using beta-LFPs to modify aDBS have shown motor improvement, 6,18 less speech impairment, 19 and less levodopa-induced dyskinesia compared to cDBS, 20 which suggests that this is a more efficient and effective method of stimulation. Moreover, a recent study demonstrated the feasibility and beneficial effects on motor symptoms of aDBS over the course of 8 hours in akinetic-rigid PD patients.…”

Section: Adbs Based On Electrophysiological Recordings Basal Ganglia mentioning

confidence: 99%

An update on adaptive deep brain stimulation in Parkinson's disease

et al. 2018

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Advancing conventional open‐loop DBS as a therapy for PD is crucial for overcoming important issues such as the delicate balance between beneficial and adverse effects and limited battery longevity that are currently associated with treatment. Closed‐loop or adaptive DBS aims to overcome these limitations by real‐time adjustment of stimulation parameters based on continuous feedback input signals that are representative of the patient's clinical state. The focus of this update is to discuss the most recent developments regarding potential input signals and possible stimulation parameter modulation for adaptive DBS in PD. Potential input signals for adaptive DBS include basal ganglia local field potentials, cortical recordings (electrocorticography), wearable sensors, and eHealth and mHealth devices. Furthermore, adaptive DBS can be applied with different approaches of stimulation parameter modulation, the feasibility of which can be adapted depending on specific PD phenotypes. Implementation of technological developments like machine learning show potential in the design of such approaches; however, energy consumption deserves further attention. Furthermore, we discuss future considerations regarding the clinical implementation of adaptive DBS in PD. © 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.

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Adaptive deep brain stimulation controls levodopa‐induced side effects in Parkinsonian patients

Cited by 108 publications

References 6 publications

Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy

Adaptive Deep Brain Stimulation for Movement Disorders: The Long Road to Clinical Therapy

Acute effects of Adaptive Deep Brain Stimulation in Parkinson’s disease

An update on adaptive deep brain stimulation in Parkinson's disease

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